However, patients with PCS have a lot of trouble adjusting and getting back to work and often require development of structured day-to-day lives, supervision, and a lot of social support

in order to function successfully Brain vascular disease With an annual incidence of more than 600 000 cases, stroke8 is the third leading cause of death in the US. Advances in modern medicine have greatly increased the poststroke survival rate. Currently about 4.5 million American adults are living with complications of stroke. Psychiatric syndromes associated with stroke lead to significant psychological distress, functional impairments, poor rehabilitation outcomes, and excess mortality.9 The most common psychiatric disturbances seen after stroke Inhibitors,research,lifescience,medical include cognitive impairment and dementia, depression, mania, anxiety disorders, and pathological laughing and crying – now referred Inhibitors,research,lifescience,medical to as involuntary emotion expression disorder or IEDD.10 Cognitive deficits of several types have been reported, typically in relationship to the location of brain injury. Left-hemisphere strokes frequently cause dysphasia, whereas righthemisphere strokes are associated with anosognosia, inattention, impaired spatial reasoning, and PXD101 cost neglect syndromes. Motivation, memory, judgment, and impulse control may be affected after frontal

stroke. Additionally, brain vascular disease is associated with the emergence of dementia. This can be the result of one stroke affecting Inhibitors,research,lifescience,medical a single critical area, such as the thalamus, several strokes affecting areas important to cognition, or chronic vascular insufficiency leading to white-matter Inhibitors,research,lifescience,medical changes with associated cognitive problems (“vascular cognitive impairment”11). Finally, brain vascular

disease and vascular risk factors have been associated with greater risk for, and acceleration of, the progression of Alzheimer’s dementia.12 Poststroke depression Inhibitors,research,lifescience,medical (PSD), characterized primarily through the work of Robinson et al,13 can be differentiated from demoralization related to stroke based on its severity and enduring nature. Both major and minor depressive syndromes have been associated with stroke, with Dipeptidyl peptidase major depression being better characterized. Twenty-five percent of patients hospitalized with an acute stroke develop major depression which is phenomenologically indistinguishable from idiopathic major depression.14 Left untreated, poststroke major depression appears to persist for 1 year in most cases, but then often attenuates into a minor depression without fully remitting. Longitudinal studies suggest that poststroke major depression, and possibly minor depression, are major determinants of disability, failure to return to work, impaired interpersonal functioning, and mortality.15 The causes of PSD have been controversial, although the balance of the evidence indicates that anterior and possibly left-sided lesions are more likely to bring about depression.16 Prevention of PSD is now an important priority.